HACA Trial

What was the research question?

• ·Does mild systemic hypothermia increase the rate of neurologic recovery after resuscitation from cardiac arrest due to ventricular fibrillation?

How did they do it?

• A multicenter trial with blinded assessment of the outcome in Nine centers in five European countries participated in the study.

• 275 patients who had return of spontaneous circulation after resuscitation for cardiac arrest due to ventricular fibrillation were randomized to undergo therapeutic hypothermia (target temperature, 32°C to 34°C, measured in the bladder) over a period of 24 hours (136 patients) or standard treatment with normothermia (137 patients).

• Patients who responded to verbal commands post arrest were excluded.

• The primary end point was a favorable neurologic outcome within six months after cardiac arrest based on Pittsburgh cerebral-performance scale 1-2 [ 1: good recovery, 2: moderate disability, 3: severe disability, 4: vegetative state, and 5: death).

• Secondary end points were mortality within six months and the rate of complications within seven days.

What did they find?

• Favorable neurologic outcome was significantly better in the hypothermia group compared to the normothermia group (55% vs. 39%, P=0.009).

• Mortality at six months was also significantly better in the hypothermia group compared to the normothermia group (41% vs. 55%, P=0.02)

• The complication rate did not differ significantly between the two groups. Minor/major bleed (26% vs. 19%), pneumonia (37% vs. 29%), and sepsis (13% vs. 7%).

What does it mean?

• Therapeutic mild hypothermia increased the rate of favorable neurological outcome and reduced mortality in patients who were successfully resuscitated after cardiac arrest due to ventricular fibrillation.

• Hypothermia became a standard of care for all patients who had ROSC after cardiac arrest if there was no contra-indication.